Thursday, March 12, 2009

Disorientation

This evening, as I was heading out the back door of the lab across the street to the doctor's parking deck, a car stopped - it was headed toward the ER. The guy in the passenger seat, 40-something with a short graying beard and ball cap, rolled down the window and stuck his head out.

"Which way do we go to get to ICU South?"

I go to ICU South frequently to do apheresis treatments - it is a hotbed of Guillain-Barre, myasthenia gravis, new acute leukemia patients with massively high white counts, thrombotic thrombocytopenic purpura (TTP) and many other indications to have your body hooked up to a giant washing machine that scrubs the individual disease's offending agent, whatever one is threatening your life at the moment, out of your blood. Nevertheless, I paused, and answered sheepishly,

"Well, you know, I go there in the building all of the time. But I can't seem to translate from where we are, here, outside the hospital. Let me think about it a minute."

They stared at me expectantly - I was wearing scrubs, I looked somewhat official - as I struggled through the route in my mind, trying in vain to figure out where to begin to point them in the right direction.

This is not a new sensation for me. I first started driving at age 14 on a hardship (a 1983 Oldsmobile Toronado convertible - wreck-proof, well-tested) - I had three younger siblings and my parents were itching for an extra driver in the family. I was completely clueless how to get anywhere. Major roads like Markham, Cantrell, and University were a mystery. I had no map in my head, didn't understand what ran parallel to what, and needed assistance even to get to the neighborhood video store. My friends and family where aghast. After all, I was born here and had grown up here; yet put me behind the wheel, and it was like I had been dropped on a different planet. I got the same question over and over.

"Gizabeth, what have you been looking at in the car, for the past 14 years of your life?"

I guess I usually had my nose in a book or my head in the clouds.

These incidences repeated themselves: I remember once, at 15, trying to get to Conway for the first time to a college party. It was still broad daylight, but somehow I got the directions confused and ended up in a continuous loop around Little Rock, winding around I-630 and I-40. Finally, after 2 hours and many loops, I realized I had to overcome my stubbornness and call my dad for help or I wasn't going to make it. He listened incredulously to my frustrated torment and figured out immediately what I was doing. He pointed me in the right direction - one of many times.

By far the most traumatic experience I have had involving lack of orientation occurred during a gross anatomy exam in medical school. I have always thrived and succeeded in test-taking situations; that's how I got into medical school in the first place. I often had nerve-wracking, sweat-inducing dreams during spring/Christmas break about receiving devastating news regarding grades on my recent trimester finals, but I rarely made anything below an A.

When you walk into a gross anatomy exam (at least at the time, the computer age was quickly advancing and had taken over micro by my second year) you are handed a clipboard and a piece of paper with blank lines numbered 1-60. There are 60 stations, with one minute allotted at each station. Station change is signaled by an egg timer. Each station contained a body, on a stainless steel gurney with a flagged pin in either a muscle, nerve, blood vessel, or organ on the region of the body we were studying at the time. There was a tall bar stool to sit at and ponder the position of the pin, but if you had studied and knew the answer, it rarely took the full 60 seconds.

Unless you are the student in our class who demanded unlimited time to name that pin because of a documented condition of Attention Defecit Hyperactive Disorder (ADHD - I am sure you have heard of it), requiring medication, to which the administration eventually begrudgingly assented. The rest of us whispered angrily when you weren't around. "What if he (oops or she) is in the ER and a patient comes in bleeding to death? Will he get extra, unlimited time to save that patient's life because of his A-D-H-D?" We drew the acronym out mockingly, and bitterly. First year medical students are pretty darned bitter, in general. But I digress.

The segment we were studying at the time was pelvis. They did something kind of interesting, in order to "preserve the body's dignity" - even medical school gets more politically correct every year. The only region of the body that was uncovered, at any time, was the one that we were studying. The rest was draped in white sheets. The head was saved for last, so we never saw the face of the body we were working on for six months until the very end. Pelvis was somewhere in the middle of the semester, so much of the body had already been dissected and distorted. And these bodies, the first dead bodies that many of us had encountered, were not like the nice (I use that word in the best possible way - fresh bodies are a million times easier to dissect), fresh specimens we get to work on at autopsy. They had been pickled in preservatives so that they would last for six months without starting to decompose and stink up the room.

There is an intricate system of vessels, muscles and nerves that runs through the pelvis. In order to prominently display the test question at each station, bodies were shifted sideways and sometimes laid prone. However, with the sheets draping the rest of the cadaver, I found it impossible gain orientation. Suddenly, those dreams I had been having my whole life had become a reality. The first 60 seconds went by and I had absolutely no idea what I was looking at. I began to sweat, but knew that if I just concentrated and kept my head on straight I would get it together. I went through another 10 or 15 stations and it still didn't happen. It was getting harder and harder to convince myself that this was going to turn out ok.

Strangely, instead of freaking out, I became serene and calm, almost like an out of body experience. Maybe this was a dream (not). It sure was the longest gross test I had ever taken; each 60 second segment seemed to drag on for an hour - highlighting my lack of knowledge even more dramatically. At one point, I experienced magical thinking, "Surely if I am struggling this hard, everyone else is too, and this test will be thrown out." But the cold hard fact that the others in my group seemed to be writing down answers on the page did not support this hypothesis.

About three-fourths of the way through, I sat down around number 45 and half-heartedly attempted to orient myself. I would be over-exaggerating to say I had written absolutely nothing down - I had studied and was making some educated guesses. But that's all they really were - guesses. Suddenly, I glanced back and noticed that the sheet had fallen off of the cadaver's head. I was having my first encounter, outside of a funeral, with a dead person's face. I supposed she was in her mid-60's, curly, graying hair, slack jaw - the preservatives had not been kind to her features. She looked waxy, but not in the "trussed-up-Catholic-wake" way, more in an "ignored person in a wheelchair in the corner of a nursing home" way. My out-of-body experience gained an exponential or two, as I craned my neck to keep catching glimpses of her for the next few stations, until it was no longer feasible.

Toward the end of the test I picked up momentum. It was the verumontanum that triggered my brain. Thank goodness for the verumontanum. It lies about 2/3 of the way down the prostatic urethra. The opening in the middle of this smooth eminence is the prostatic utricle, a slitlike opening that is considered to be the homologue of the female vagina - the vagina masculina. The ejaculatory ducts lie on either side of the utricle, but they are not visible to the gross eye.

I got the next few questions, but not enough to keep me from my dreaded first F. I learned that there are no nervous, sweaty dreams when you know you failed. Luckily, it was a high F, and I still managed to pull a B in the class.

I turned to the guys in the blue Chevy and pointed across the lab and the helicopter pad to the main hospital. "ICU South is over there. At the far end of the main hospital." I smiled. "Good luck." I walked to my car and headed home, grateful that I was able to orient myself, and them.